Mary Nkhoma from Nkwanzi area in Mchinji knows how tricky it is to access youth friendly health services (YFHS)—and even information on sexual reproductive health rights (SRHR)—with her parents’ help.
“At 14, I can’t dare my parents to talk about the condom use because I am regarded as young. My father once told me that condoms are meant for older people, not children,” she says.
Mary fears she could be in trouble if members of her community spotted her at a health centre trying to access contraceptives or HIV testing and counselling (HTC).
“I would be in trouble if I were seen getting condoms or an HIV test. Apart from being asked questions and suspected of wrongdoing, some community members who know me would instantly report to my parents. It is regarded a taboo for a child like me to access sexual reproductive health (SRH) services such as information on HIV and sexuality.
“The only time they would expect me to be found at a hospital is when I’m sick. Otherwise, they would suspect me of committing a serious offence such as abortion or unprotected sex,” she says.
One thing for sure is that Mary, as a teenager, is faced with growing peer pressure and desire for sex, but she is in a dilemma about whether she should use condoms or abstain. But what will happen to her if she fails to abstain or access a condom?
“We cannot deny the fact that adolescents are engaged in sexual intercourse these days. The tricky part, however, is that they face difficult choices to make about whether to abstain or use a condom. As a result, adolescents are forced to have unprotected sex because their parents and relations are not keen to openly talk about issues of their reproductive health and access to youth friendly health services within their families,” says Steven Nyika, a safe motherhood coordinator for Mchinji District Hospital.
Nyika says when teenagers are exposed to either sexually transmitted infections (STIs) or unplanned pregnancies; culture prevents them from seeking medical help.
“Oftentimes, adolescents fear stigma to seek medical assistance because society teaches them that they are not supposed to engage in sexual activities in the first place, let alone seek contraception to avoid getting pregnant or contracting STIs. This is one of the biggest cultural problems we are struggling with as health workers; young people shunning medical help because of cultural beliefs,” says Nyika.
Mary is just one of many adolescents that are faced with cultural barriers that form the reality of many communities in Malawi. As part of social and cultural construction, these beliefs heavily interfere with emerging issues and efforts that are aimed at addressing human rights that relate to women and young girls’ ability to make sexual and reproductive choices.
According to the National Youth Friendly Health Services Strategy (NYFHSS) for 2015-2020, only 13 percent of youthful population under 25 years of age has ever used YFHS and only 31.7 percent have heard of the same. This means that there are unprecedented new HIV cases and unintended pregnancies that are slowly killing young people, especially adolescents.
The report further states that early sexual debut continues to persevere with a staggering 20.3 percent boys and 5.3 percent girls having had sex by the age of 10. This contributes to the soaring school dropout rates among adolescent girls due to unintended pregnancies and early and child marriages.
The absence of quality YFHS that provide young people with information and services results in poor comprehensive information on sexual reproductive health rights. Almost 42 percent of young women and 45 percent of young men between the ages of 14 and 24 years fully understand the concepts of HIV and Aids.
The report also reveals that there are 3 200 new infections of HIV annually among young people between the ages of 14 and 19 years only. While there is progress in curtailing the prevalence of HIV among youth, the occurrence is still higher among females than males (12.9 percent against 8.1 percent).
Currently, Malawi has also one of the highest adolescent fertility rates in sub-Sahara with a staggering 143 per 1 000 live births; with 45.7 percent of maternal deaths between 2008 and 2010 among females within the age bracket of 14 and 23 years. As the rate of early and forced marriage stands at 49 percent, there are 106 000 teenage pregnancies annually.
Experts have since warmed drastic consequences if the situation is left unchecked.
Malawi’s country coordinator for Population Reference Bureau (PRB), Sandra Mapemba, said disregarding young people’s health needs is waging a war against meaningful development because health has a direct bearing on Malawi’s development index.
“Due to poor youth friendly health services, which the country has, there are likely to be increased population and new HIV infections, unplanned pregnancies, early and forced pregnancies among young people. And this will in the end bear severe consequences on the country’s little resources,” said Mapemba.
But as cultural beliefs continue to prevent adolescents from accessing the right information or YFHS such as contraception, stigma also comes into play to fuel the HIV and Aids pandemic and unplanned pregnancies and prevent adolescents from accessing medical support.
However, responding to the crisis, Girls Empowerment Network (Genet-Malawi), with support from Southern Africa Aids Trust (SAT), implemented a Happy Health project in Mchinji, Blantyre and Mzimba to curb new HIV infections and promote issues of SRH and YFHR among adolescents.
“Apart from highlighting the poor situation of YFHS and SRH in rural communities of T/A Mavwere, the project is creating an enabling environment for YFHS delivery, guarantees strict adherence to YFHS standards, strengthens synergies between sectors, increase youth and community participation,” said Lindiwe Jere, project manager for Genet-Malawi.
The project is working towards complementing Malawi’s National Sexual and Reproductive Health Programme, which is earmarked to facilitate the attainment of family planning 2020 commitment. Presently, Malawi has over 5 million young people in need of YFHS against meagre allocation of resources.
According to SAT’s country manager Robert Mangwazu Phiri, young people remain in the forefront of the HIV and Aids epidemic in the African region. SAT supports programmes that are in line with international and regional agreements, such as declarations, resolutions and outcome documents as useful advocacy tools, such as the Maputo Plan of Action, to achieve the Millennium Development Goals (MDGs) relating to young women’s sexual and reproductive health rights. MDG 3 aims to promote gender equality and empower women, MDG 4 aims to improve maternal health for all women, including young women and MDG 6 aims to combat HIV and Aids.
To achieve this, Genet-Malawi has set up community structures that support adolescents’ to access SRH and YFHS such as HIV testing and counselling without fear of prejudice or discrimination. Currently, Genet-Malawi has enhanced the capacity of 126 (47 female, 69 male) local leaders from three target districts for them to promote community responses to HIV.
This has resulted in the formulation and strengthening of local bylaws in the communities to abolish negative traditional practices, attitudes and beliefs surrounding adolescents health rights.
T/A Mavwere said he was committed to helping adolescents from his area to access SRH and YFHS to boost their health.
“Health rights are integral to communities’ efforts of supporting adolescents to develop community-based programmes that are effective, efficient and sustainable. I am continuing to mobilise my subjects to fight harmful and promote young people’s access to SRH and YFHS to ensure their full utilisation and knowledge enhancement on health rights,” said Mavwere. n